Although interventions using cue exposure for addiction have a sound theoretical rationale and are well grounded in animal learning studies, treatments using this approach have not been well supported. Two particular problems related to exposure- based treatments for addiction are: (1) reliably re-creating conditioned responding and extinguishing cravings to a variety of conditioned stimuli in the therapeutic environment and (2) generalization of extinguished responses to drug-related stimuli in the patient's natural environment. In a previous Stage Ia/b treatment development project (DA-R01- 018311), our group developed and found promising empirical support for the use of a novel computer-based intervention as an adjunct to a manualized and NIDA approved weekly Individual and Group Drug Counseling for cocaine dependence (Combined IDC and GDC; I/GDC; Daley et al., 2003; Mercer & Woody, 1999). Consistent with the mission of Stage II behavioral therapy development (Rounsaville, Carroll, & Onken, 2001), the primary aim of the present application is to follow the earlier Stage Ia/b project by examining the efficacy of a virtual reality-based (VR) cue exposure and cellular phone-based extinction reminder (ER) platform as an adjunctive intervention to I/GDC. Using a treatment manual previously developed that details the rationale and parameters of the VR/ER intervention, we will conduct a Stage II randomized controlled trial in order to rigorously evaluate the efficacy of this novel intervention. Specifically, 180 adult outpatients with crack cocaine dependence will be randomly assigned to receive 6 months of I/GDC alone (weekly individual and group counseling) or I/GDC + VR/ER. In addition to primary analyses examining treatment effects on cocaine use through thrice weekly urinalyses, additional analyses will evaluate differences in retention, other substance use, HIV risk behavior, and mediators/ moderators of treatment outcome across conditions. Comprehensive assessment measures, including measures of physiological and subjective cue reactivity, will be administered at pre-treatment, post- treatment, and 6-month follow-up. PUBLIC HEALTH RELEVANCE: In this project, we will evaluate the efficacy of a new intervention that uses two computer-based interventions as an addition to weekly group and individual drug counseling for cocaine addiction. Specifically, (1) inside the clinic we will use virtual reality to directly train new biobehavioral responses (i.e., less craving) to people, places, and things associated with drug use, and (2) outside the clinic we will use an automated server and cellular phones to provide reminders of newly learned biobehavioral responses from the virtual reality training. If the combination of the new intervention with weekly drug counseling leads to significantly better retention in treatment and less cocaine use compared to drug counseling alone, the results will provide a novel empirically supported approach to the treatment of addiction.